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PubMed2006

Nitric oxide in cerebrospinal fluid and local inducible nitric oxide synthase after cauda equina compression in rats.

We investigated the time course of changes in nitric oxide metabolite (NO2- plus NO3-: NOx) levels in the cerebrospinal fluid and the expression of local inducible nitric oxide synthase following cauda equina compression in rats. Cerebrospinal fluid NOx levels were significantly increased from 12 h to 3 days after compression, and decreased thereafter. Histologically, inducible nitric oxide synthase immunoreactivity was observed in macrophages that infiltrated the dura mater on days 1 and 3 after compression, but not in foamy macrophages in the parenchyma of the cauda equina observed afterwards. The pattern of NOx levels coincided with the appearance of inducible nitric oxide synthase labeled macrophages, indicating a critical role of these cells as the main synthesizers of NOx in the acute stage of cauda equina compression.

Animals↗
PubMed2001

[Cauda equina compression: report of 20 cases].

The authors report in a retrospective study, 20 cases of cauda equina compressions operated in the Neurosurgical department of the University Hospital of Dakar. Clinical aspects, aetiologies, and prognosis are discussed. Cauda equina compressions represented 13.2% of all medullar and radicular compressions. Diagnosis was delayed with a mean duration of 11.2 months. Chronic lumbar pain is the main initial sign, diagnosis is made at the state of paraplegia with sphincter dysfunction. Lumbar canal stenosis (40%) and herniated disc (30%) were the most frequent causes, tumors were rare. Surgical treatment gave good results about motor deficit; urinary incontinence is a frequent sequella. The authors emphasize an early diagnosis for prognosis improvement.

Adult↗
PubMed1986

L7-S1 fixation-fusion for treatment of cauda equina compression in the dog.

The L7-S1 fixation-fusion technique for treatment of cauda equina compression was performed on 14 dogs, 13 of which were 6 years old or older, were severely lame, and had ventral bridging spondylitis at the L7-S1 vertebrae. One dog, 3 months old, had a congenital malformation of the L7 vertebra. The principles of the L7-S1 fusion technique were to expand the L7-S1 intervertebral foramina and spinal canal, remove pressure on the nerve roots, and provide stability to the L7-S1 vertebrae. This technique appeared to be applicable clinically for restoring normal function and activity to dogs with cauda equina compression.

Animals↗
PubMed2006

Paragangliomas of the cauda equina. Report of one case and review of the literature.

The authors report one case of cauda equina paraganglioma and review the neurosurgical, radiological and pathological literatureon this rare tumour. Although it is difficult to distinguish preoperatively the paraganglioma from other tumours of the cauda equina, like neurinoma or ependymoma, this neuroendocrine tumour should be included in differential diagnosis.

Cauda Equina↗
PubMed1978

Redundant nerve roots of the cauda equina. A report of five cases.

Five personally examined cases of redundant nerve roots of the cauda equina are added to the 13 hitherto on record. Except for segmental neurological deficits, intermittent claudication-like symptoms of the cauda equina dominated the histories of four of our five cases. The diagnosis was confirmed at surgical exploration, which included laminal and dural decompression. At follow-up (two months--three years) the neurological deficit, or the intermittent claudication, or both, had improved in all our patients. The pathogenesis of root redundancy is obscure. It seems that the symptoms arise through the action of at least two factors viz compression of the spinal content and the existence of one or more redundant roots. Wider use of diagnostic aids and surgical exploration would probably show that redundant roots are more common than hitherto supposed.

Aged↗
PubMedDate not supplied

Multiple neurilemmoma of the cauda equina. A case report.

A 49-year-old male, with a relatively uncommon multiple neurilemmoma, exhibited symptoms of cauda equina compression. Following a diagnosis of multiple tumor of the cauda equina and extradural cyst, based on myelography and CTM, the tumors at L1-L2, the left S1 nerve root, and left hip were resected. Three years after the operation, the patient is asymptomatic apart from slight numbness in the right hip and there is no evidence of tumor recurrence. The rarity of such a case prompted this report.

Cauda Equina↗
PubMed1979

Experimental neurogenic disorders of the bladder after section of cauda equina.

Changes in the cystometric pattern and urethral pressure profile after surgical section of the cauda equina have been studied in a group of 20 monkeys (Macaca nemestrinal). The experimental autonomous bladder was characterised by tonic response to filling and with variable urethral dribbling incontinence but without co-ordinated detrusor activity. This pattern developed despite previous urinary diversion to prevent inadvertent overstretch of the bladder. Deliberate "overstretch" of the autonomous bladder was not followed by loss of tonus but was associated with the development of high amplitude regular detrusor contractions which were superimposed upon a steep rising filling cystometrogram. With urinary diversion the resting urethral pressure profiles were preserved after division of the cauda equina but were lower in amplitude after overstretch of the autonomous bladder.

Animals↗
PubMed1990

Cauda equina syndrome of long-standing ankylosing spondylitis. Case report and review of the literature.

Cauda equina syndrome as a neurological complication of long-standing ankylosing spondylitis was first reported in 1961. The syndrome is relatively uncommon and its pathophysiology is still poorly understood. Based on their experience with such a case, the authors review the clinical, electrographic, histological, and radiographic features of the syndrome, including the findings of magnetic resonance (MR) imaging. The addition of MR imaging to the evaluation of patients with ankylosing spondylitis and the cauda equina syndrome not only aids in the diagnosis of the syndrome but may also provide valuable insight into the pathophysiology of this condition.

Cauda Equina↗
PubMed1982

Surgical monitoring of spinal cord function: cauda equina stimulation technique.

Spinal cord and subcortical brain stem evoked potentials had an amplitude at least 2 times higher when the cauda equina rather than bilateral peripheral nerves was stimulated. Cauda equina stimulation is indicated when potentials to peripheral nerve stimulation are absent or are too low in amplitude to permit reliable surgical monitoring. The technique is essentially without risks, but should be performed with a small lumbar puncture needle (21 to 22 gauge), and is contraindicated in patients with general infections, increased cerebrospinal fluid pressure, or a hemorrhagic tendency (thrombocytopenia or anticoagulant therapy).

Cauda Equina↗
PubMed1991

Paraganglioma of the cauda equina. A case report and review of the literature.

A case of paraganglioma of the cauda equina is reported. The patient was a 55-year-old Japanese woman who complained of lower back pain and gradual weakening of the left lower extremity, she was diagnosed as having a spinal cord tumor, and the tumor was removed surgically. Histologically, the tumor was encapsulated, and consisted of solid nests of large, polyhedral epithelioid cells with abundant eosinophilic cytoplasm. The nests were separated from each other by a thin fibrovascular stroma. Grimelius staining revealed neurosecretory granules in the cytoplasm of the tumor cells. This was further confirmed by electron microscopic observation. The tumor cells were immunohistochemically positive for neuron-specific enolase (NSE), but negative for glial fibrillary acidic protein (GFAP). On the basis of the histologic, immunohistochemical and electron microscopic features of the tumor cells, the tumor was diagnosed as paraganglioma. The cauda equina is a rare location for this type of tumor, and only a limited number of cases have been reported.

Cauda Equina↗
PubMed1994

Intraoperative motor and sensory monitoring of the cauda equina.

A set of standard techniques to monitor the motor and sensory function of the cauda equina is proposed for surgery in the lumbosacral spinal canal for the release of a tethered cord or the removal of a neoplasm. Continuous loudspeaker-controlled recording of electromyographic activity in four leg muscles of both sides supplied the surgeon with immediate feedback on injury to any of the motor roots from the second lumbar to the fourth sacral segment. Continuous recording of tibial nerve somatosensory evoked potentials yielded information about the functional state of parts of the lumbosacral sensory pathways. Motor roots could be identified by electrical stimulation in the operating field with bipolar stimulation forceps and recording of compound muscle action potentials from the leg muscles. Sensory nerve roots could be identified by nerve root somatosensory evoked potentials recorded from the scalp after the electrical stimulation of the exposed nerve. This set-up is a combination of previously developed monitoring techniques and provides the surgeon with functional information: 1) continuous feedback on the state of the endangered motor and sensory function of the cauda equina; and 2) rapid anatomical identification of nerve roots and their distinction from fibrous or neoplastic structures.

Adolescent↗
PubMed1995

Production of chronic compression of the cauda equina in rats for use in studies of lumbar spinal canal stenosis.

STUDY DESIGN: The pathophysiology of lumbar spinal canal stenosis was analyzed with a new model in rats. OBJECTIVES: To produce chronic compression of the cauda equina in rats for analysis of the pathophysiology of lumbar spinal canal stenosis. SUMMARY OF BACKGROUND DATA: Models of compression to date have involved acute or subacute compression. A model of chronic compression has not been available. METHODS: A stainless steel wire fastened around the spine at L5 in 3-week-old rats, with a plate inserted against the ventral aspect of the vertebra to protect it from the wire. as the rats grew, the wire cut into the spinal canal. One year after the operation, canal stenosis was present without paralysis of the back limbs. RESULTS: Stenosis seen in sagittal sections, as a percentage of the original width, was 51.6 +/- 6.2% (mean +/- standard deviation). In histologic analysis of the region near the wire, findings included axonal degeneration, demyelination, vacuolar degeneration of the nerve fibers, and narrowing the intradural blood vessels with a decrease in their number. Cephalad and caudad to the wire, congested intradural blood vessels, degenerative foci near these congested vessels, fibrosis around these foci, congested epidural vessels, and fibrosis around these vessels were observed. During electrophysiologic analysis (six rats with stenosis), the conduction velocity of the cauda equina was found to be delayed. CONCLUSIONS: The histologic and electrophysiologic findings in this animal model were similar to findings in human subjects, so rats prepared in this way should be useful for study of chronic compression of the cauda equina.

Animals↗
PubMed1991

Subarachnoid hemorrhage from multiple neurofibromas of the cauda equina: case report.

The authors report a case of spinal subarachnoid hemorrhage caused by neurofibromas of the cauda equina. An examination of the literature revealing 13 similar cases and an analysis of this case showing three neurofibromas of the cauda equina prompted an hypothesis emphasizing the origin of bleeding and the difficulties associated with a correct diagnosis.

Cauda Equina↗
PubMed2007

Epidemiology of cauda equina and conus medullaris lesions.

The epidemiology of cauda equina and conus medullaris lesions is not well known, and this study aimed to provide further information on this topic. In the period 1996-2004, patients fulfilling the clinical, electrodiagnostic, and radiological criteria for such lesions were identified. For cauda equina/conus medullaris lesions an annual incidence rate of 3.4/1.5 per million, and period prevalence of 8.9/4.5 per 100,000 population were calculated. The values obtained are probably valid estimates of the incidence and prevalence of these lesions in developed countries.

Adult↗
PubMed1999

Cauda equina syndrome due to lumbosacral arachnoid cysts in children.

We describe the clinical, neuroradiological and surgical aspects of two children in whom symptoms attributable to cauda equina compression were caused by spinal arachnoid cysts. The first patient presented with recurrent urinary tract infections due to neurogenic bladder dysfunction, absent deep tendon reflexes and sensory deficit in the lower limbs. The second child presented with unstable gait as a result of weakness and diminished sensation in the lower extremities. Spinal magnetic resonance imaging revealed a lumbosacral arachnoid cyst in both patients. During surgery the cysts were identified and excised. Two years after surgery, the sensory deficits of the first patient have disappeared and patellar and ankle reflexes can be elicited, but there is no improvement in bladder function. Neurological examination of the second patient was normal. We conclude that the diagnosis of cauda equina syndrome should prompt a vigorous search for its aetiology. Lumbosacral arachnoid cysts are a rare cause of cauda equina syndrome in children.

Arachnoid Cysts↗
PubMed1998

[A free meningioma of the cauda equina].

We report an unusual case of a cauda equina meningioma occurring in a young girl. This tumor was neurinoma-like. No meningeal attachment was identified in the neuroradiological study and during its microsurgical removal.

Adolescent↗
PubMed1990

Importance of compression onset rate for the degree of impairment of impulse propagation in experimental compression injury of the porcine cauda equina.

The effects of a rapid (0.05-0.1 seconds) and a slow (20 seconds) onset rate of cauda equina compression on impulse propagation, in terms of tail muscle electromyogram (EMG) amplitude, were analyzed in an experimental model of the pig cauda equina. Sham compression and compression at 50 mm Hg at either rapid or slow onset induced no or only minor functional impairment. Compression at 100 or 200 mm Hg induced impairment of the impulse propagation that was proportional to the applied pressure. The effects were more pronounced (P less than 0.01) for the rapid than for the slow onset of compression at both these pressure levels. An important factor for this observed difference in effects between the two employed onset rates seems to be the magnitude of intraneural edema formed outside the compression zone.

Animals↗
PubMed1987

[The blood supply of the cauda equina of the cat].

The angioarchitecture of the cauda equina of the cat has been described. The surgeon has to pay attention when operating in this region, because of the arrangement of the vessels and also of the density of the capillary network.

Animals↗